For Your Child

Low-Fat Milk Can Be a Healthy Choice for Toddlers

For babies ready to graduate from breast milk or formula to cow's milk, the longstanding recommendation has been that they receive whole milk, instead of reduced-fat or fat-free milk.

But new guidelines from the American Academy of Pediatrics (AAP) now advise parents of toddlers who are overweight or obese, or those who have a family history of obesity, high cholesterol, or cardiovascular disease, to switch to reduced-fat milk between ages one and two years.

The new guidelines in the medical journal Pediatrics are part of a long list of new recommendations aimed at keeping children's cholesterol levels down to protect their long-term heart health.

"If you read the guidelines, the AAP has definitely changed their idea on this," says nutritionist Ann Condon-Meyers, of the Children's Hospital of Pittsburgh. "They're saying if you're between 12 months and 12 years, and you have certain risk factors, the use of reduced-fat milk would be appropriate."

That is a departure from previous thinking that held that whole milk, and the fat it contains, was essential to the proper development of a baby's brain, especially since milk is such a major component of the toddler diet.

Low-Fat Milk Still Provides Some Fat

Condon-Meyers says past recommendations were not based on evidence from studies, but developed more from experience and common sense.

Breast milk is high in cholesterol, she explains, and babies fed breast milk have good cholesterol levels - not high, but not low either.

One likely reason that nature provides a reasonable amount of fat in breast milk is that fat is vital to the development of the myelin sheath in the brain, says Condon-Meyers.

"That's why we worry about children not receiving enough whole fat," she explains.

Whole milk contains between 3.5 percent and 3.8 percent fat, while reduced-fat milk contains 2 percent fat, according to Condon-Meyers, who adds that the term reduced-fat is synonymous with 2 percent.

The reason reduced-fat milk should be fine for kids who are overweight or obese, or have family risk factors such as high cholesterol, is that they will still be getting some fat in the milk, and they may already have sufficient levels of fat in their bodies.

After Age Two Non-Fat Milk Is Okay

Condon-Meyers says she would want to carefully evaluate the diet of a child who is a vegetarian because cow's milk may be his or her best source of saturated fat, and children need a small amount of saturated fat to develop properly.

"Our research on children and cholesterol is definitely in its childhood phase. It's really a work in progress," she adds.

After age two, parents should start giving toddlers whatever milk the rest of the family drinks, and at that time, even skim (fat-free) milk is fine, Condon-Meyers says.

"Provided it's not the mainstay of a child's diet, children can make the transition to low-fat or skim milk, regardless of other risk factors," she says.

October 2008

Toddler Nutrition

The toddler (ages 1 to 3 years) phase can often be challenging when it comes to feeding.

Several developmental changes occur at this time. Toddlers are striving for independence and control. Their growth rate slows down and with this comes a decrease in appetite.

These changes can make meal time difficult. It is important for parents to provide structure and set limits for the toddler. The following are suggestions to help manage mealtimes so that the toddler gets the nutrition he/she needs:

Avoid battles over food and meals.

Provide regular meals and snacks.

Be flexible with food acceptance as toddlers are often afraid of new things.

Be realistic about food amounts. Portion size should be about one-fourth the size of an adult portion.

Limit juice intake to about 4 to 6 ounces per day.

Dessert should not be used as a reward. Try serving it with the rest of the food.

Make the food easy for your toddler to eat by cutting food into bite-sized pieces; making some foods soft and moist; serving foods near room temperature; using ground meat instead of steak or chops; using a child-sized spoon and fork with dull prongs; and seating your child at a comfortable height in a secure chair.

According to the Dietary Guidelines for Americans 2005 (the most recent guidelines), a decrease in energy intake of 50 to 100 calories per day for children who are gaining excess fat can reduce the rate at which they gain weight. With this reduction in energy intake, they will grow into a healthy weight as they age. Help your child to find higher-calorie foods that can be cut from his/her daily intake.